Resuscitation
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To investigate the response to cardiac arrest in general wards. ⋯ The majority of the cardiac arrest teams have acceptable response times, but their efficiency may be impaired by the lack of staff, equipment and co-ordination with the ward personnel. CAT members identified a strong need for BLS training of ward personnel. More widespread introduction of standard protocols for resuscitation and reporting of cardiac arrest are necessary to evaluate aspects that may need improvement.
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Non-traditional and lay first responders increasingly are being trained in the skill of defibrillation. With simplification of new devices, there is a need to determine optimal first responder selection and training and maintenance of this important skill. These issues are of prime importance for the St John Ambulance Australia Operations Branch which already has a substantial first response defibrillation programme. ⋯ For St John first responders proficient in cardiopulmonary resuscitation (CPR), the skill of defibrillation with an AED is readily acquired and maintained. While less experienced members may be less likely to acquire the skill initially, once acquired the skill is equally maintained by all, provided ongoing 'on duty' exposure is available.
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Randomized Controlled Trial Clinical Trial
Factors influencing Queenslanders' willingness to perform bystander cardiopulmonary resuscitation.
The chances of surviving an out-of-hospital cardiac arrest (OHCA) are greatly increased if a bystander provides cardiopulmonary resuscitation (CPR) while awaiting the arrival of the emergency medical services. Over 50% of adult Queenslanders have been trained in CPR at some time in the past, however, little is known about the factors that affect their willingness to perform CPR. ⋯ This study indicates that there is considerable variation in Queenslanders' willingness to perform bystander CPR. Public health education campaigns aimed at correcting inaccurate perceptions of risk and addressing other barriers to bystander CPR would promote its use in response to OHCA.
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Emergency oral tracheal intubations in the pre-hospital setting can be more difficult because the rescuer's position with respect to a patient lying on the ground may not provide optimal conditions for intubation. Since optimal visualisation of the larynx often depends on the force generated during laryngoscopy, we measured the pressure required for intubation (P(i)) as well as the maximum pressure (P(max)) that can be generated with the laryngoscopy blade in seven intubator positions. ⋯ The straddling position affords the intubator significantly more reserve force than the prone, right lateral decubitus or sitting position. We suggest that the straddling position may be an advantageous position for pre-hospital intubations especially when visualisation of the glottis is difficult.
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Monitoring of end-tidal carbon dioxide (EtCO(2)) is good clinical practice in the patient who is intubated and ventilated. This study investigated the EtCO(2) values in spontaneously breathing patients treated in a physician-staffed mobile intensive care unit (MICU). This article also discusses whether EtCO(2) monitoring may have an influence on therapeutic decisions by emergency physicians by providing additional information. ⋯ Although EtCO(2) monitoring may be a useful additional variable in spontaneously breathing patients. Consideration of the respective disease and the cost to benefit ratio suggests that this method should only be used for selected indications.